Extramedullary plasmacytoma of the ureter in an HIV-positive patient
Int Canc Conf J
Extramedullary plasmacytoma of the ureter in an HIV-positive patient
Takashi Nagai 0 1 2
Takehiko Okamura 0 1 2
Yosuke Taki 0 1 2
Yutaro Tanaka 0 1 2
Daichi Kobayashi 0 1 2
Takahiro Kobayashi 0 1 2
Hidetoshi Akita 0 1 2
Takahiro Yasui 0 1 2
Ureter HIV 0 1 2
0 Abbreviations EMP Extramedullary plasmacytoma CT Computed tomography CK Cytokeratin
1 Department of Nephro-Urology, Nagoya City University, Graduate School of Medical Sciences , Nagoya , Japan
2 & Takehiko Okamura
A 45-year-old Japanese man, who was undergoing HIV infection treatment, was aware that he had gross hematuria, and he was diagnosed as having a ureteral tumor by radiographic examination. Therefore, he was referred to our department for further examination and treatment. We considered that the ureteral tumor was a urothelial carcinoma (cT2N0M0) because of the left ureteral tumor and urine cytology results, and thus, laparoscopic ureteronephrectomy was performed. The pathological diagnosis was a solitary extramedullary plasmacytoma (EMP) of the ureter. Currently, he is alive and free of disease at 7 months postoperatively. EMP develops in the nasal cavity, paranasal cavity, gastrointestinal tract, lung, thyroid, eye socket, lymph node, and various organs, but the ureter is an extremely rare site of EMP. In addition, the patient had an HIV infection. To the best of our knowledge, this is the first case of EMP of the ureter in an HIV-positive patient.
Extramedullary plasmacytoma infection
-
Department of Urology, Anjo Kosei Hospital, 28
Higashihirokute, Anjo-cho, Anjo, Aichi-ken 446-8602, Japan
Introduction
A plasmacytoma is a solitary mass of neoplastic
monoclonal plasma cells in either bone or soft tissue. An
extramedullary plasmacytoma (EMP) is less common than
a solitary bone plasmacytoma, and it occurs when there is
soft tissue infiltration of clonal plasma cells [
1
]. An EMP
occurs in the nasal cavity, paranasal cavity, gastrointestinal
tract, lung, thyroid, eye socket, lymph node, and various
organs [
1
], but the ureter is an extremely rare site of EMP.
We describe a patient with an EMP in the ureter who had
an HIV infection. To the best of our knowledge, this is the
first case of an EMP of the ureter in an HIV-positive
patient.
Case report
A 45-year-old Japanese man receiving HIV infection
treatment had gross hematuria. Since the ultrasound
sonogram and computed tomography (CT) scan showed a
left ureteral tumor (Fig. 1a), he was presented to our
department for further examination and treatment. His
medical history included condylomata acuminate of the
penis, hepatitis B, and HIV infection. The HIV infection
was well controlled with dolutegravir and emtricitabine/
tenofovir. He had no significant family, allergic, or
smoking history. He received no blood transfusions. Serum
laboratory findings showed an increased creatinine level
(1.23 mg/dL; normal range \1.2 mg/dL) but no increase in
tumor markers such as the squamous cell carcinoma
antigen and cancer antigen 19-9. Results of urinalysis showed
hematopyuria, and urine cytology findings were
pseudopositive for urothelial carcinoma, of which few cells had a
high nuclear-cytoplasmic ratio and their nuclei were
hyperchromatic. On cystoscopy, no bladder tumor was
observed. A whole-body CT scan was performed, and no
distant metastasis or lymph node involvement was found.
We also conducted retrograde unilateral left pyelography
and a selective upper urinary cytology examination. The
pyelogram showed the same left ureteral mass that was
found on the CT scan. Results of the left upper urinary
cytology examination were negative; there were few
atypical cells, but their nuclei were not hyperchromatic.
We diagnosed the ureteral tumor as a urothelial carcinoma
(cT2N0M0) because of the left ureteral tumor and
abnormal urine cytology findings, and laparoscopic
ureteronephrectomy was performed. Macroscopically, a
solid, papillary tumor, 30 mm in diameter, was observed in
the upper side of the ureter (Fig. 1b). Histopathological
findings included plasmacytoma-like atypical cells with a
high nuclear-cytoplasmic ratio, perinuclear halo formation
of invasion at the periureteral soft tissue of the ureter
(Fig. 2a, b), and lymphocytic and histiocytic infiltration in
the tumor. Invasion of the tumor cells was not observed in
the pelvic mucosa or renal parenchyma. There was no
component of urothelial carcinoma in the tumor or
surrounding mucosa of the ureter. Immunohistochemical
staining was performed to confirm the definitive diagnosis.
Tumor cells were negative for cytokeratin (CK) 7, CK20,
and p63 but positive for the markers of B cells or plasma
cells, such as CD138 and CD79a/mb-1 (Fig. 2c). In
addition, light chain restriction [immunoglobulin (Ig)c [ Igj]
was observed (Fig. 2d). The final histopathological
diagnosis was plasmacytoma not urothelial carcinoma.
Fig. 2 a In the low-power field,
tumors (asterisk) invade at least
the periureteral soft tissue
(hematoxylin and eosin
(...truncated)